Case presentation:

• Male.
• 81 y.o.
• Dyslipemia, stress, overweight, family history.
• Asymptomatic with positive exercise test.
• Aortic stenosis. - EKG: synus rythm 75 bpm, mild repolarization changes.
• The patient underwent a dipyridamole/rest myocardial perfusion gated SPECT study with 99mTc-MIBI Teaching points
• Myocardial perfusion imaging is useful for identifying multivessel disease, since most patients have perfusion abnormalities indicative of ischemia.
• In few cases, balanced ischemia can produce “normal” perfusion images but frequently showing myocardial stunning with transient LV dilation and lower post-stress LVEF.
• High risk studies indicate the need for aggressive management.